Tuesday, May 26, 2009

This topic really burns me up. OK, sorry. I couldn't resist. So who can tell me what a calorie is? Any takers? Give up? All right, a calorie is the amount of heat needed to raise the temperature of one gram of water by one degree in the Celsius scale. This definition is referenced and repeated in numerous scientific and medical textbooks. Now the next question I ask is, "What the heck does this have to do with human nutrition?" The short answer is absolutely nothing. Now the longer answer.

It seems that wherever you turn someone is harping on the calorie. Calorie this and calorie that. Lower your caloric intake and you will lose weight. Increase your calories and stop exercising and you will gain weight. I am here to tell you that this is simply false.

Over the last nine years of starting my patients on low carb, more fat, more cholesterol and more protein diets, I have seen HDLs double, type 2 diabetics cured, blood pressures that were once difficult to control become normal, thousands of pounds lost, TGs lowered to normal; all this while usually increasing the caloric intake.

I actually had one patient who went from consuming 2000 calories a day to eating 6000-8000 calories a day and while keeping his exercise regimen the same, lost weight! That is correct, he increased his caloric intake, did not increase his exercise level and lost weight. This seems to defy the senses. My patient did not understand it. I did not understand it because I was ignorant. Then I did what very few doctors even dare to do when it comes to nutritional science. I started to think for myself. And I figured out why using the calorie as a dietary guide is a waste of time.I defined what a calorie is above. But how do we go about determining how many calories are in, say, a burger, or a piece of lettuce. When we buy a food product at the supermarket there is nutritional information on the side-packaging label. One of the first things we are told to look for is 'how many calories are there per serving.' So we look and we see how many calories there are.

But I still have not answered the question as to how we actually measure calories. Well it is really quite simple. What we do is we take the food item we wish to measure and burn it in a closed container. This container is filled with water and also has a thermometer in it. We watch how many degrees change on the thermometer and each degree change represents a calorie. So for instance, if we burn a quarter pound of meat in this container (called a calorimeter, by the way), and the temperature goes up two hundred degrees, that represents two hundred calories.

Generally only a single food item is burned. But one can burn the whole, say, quarter pounder with cheese and see what the degree change is; thus arriving at how many calories existed in that particular food item.The problem with the calorie is that this measurement occurs in a closed system. A closed system is one where we know everything that is happening within that system. And I mean everything.

For instance, I know what the thing weighs that I am burning; I know the size of the container I'm using; I know the starting and ending temperature on the thermometer; I know how much water is in the container, and so on.

Now, our bodies are not closed systems they are open systems. This means we have only a general idea of what happens when we eat, say, a quarter pounder. So what happens when we eat a quarter pound of meat? Well, first we need to chew this food and then swallow it. It gets to the stomach where the digestive process continues. When the meat leaves the stomach and enters the small intestine this is where the problems start.When the quarter pound of meat finds its way into the first part of the small intestine (known as the duodenum), pandemonium begins. A bunch of enzymes and hormones are released from the pancreas and small intestine, bile is secreted from the gallbladder to help with digestion and all of these enzymes interact in such a complex way that we are still trying to figure out what is going on. If any of you doctors think we, as physicians, understand the whole digestive process all I can say is sitagliptin.

For my non-physician readers I apologize, but I need to make a point to underscore the continued ignorance of us docs. For my docs, please do not take offence and do not confuse ignorance with stupidity. Stupidity is difficulty in understanding a topic, and I do not like the word at all.

Ignorance occurs when we really, truly, honestly just do not know because we just have not been smart enough to discover something yet.

OK, so I said sitagliptin. This is a new medication for type 2 diabetics only. It is a dipeptidyl-peptidase 4-enzyme inhibitor. This newly discovered entity works by interfering with certain things secreted by the intestine. No, this is not the part of the book where I lose everyone. I am just trying to make a point. We docs only found out about this over the last few years and we had no idea how important this thing was in sugar regulation. So for anyone who thinks we know it all by now, especially with digestion, you are sadly mistaken because we have only just uncovered the proverbial tip of the iceberg.

So getting back to where we were there is no way to exactly measure anything other than the weight of what you ate. That is it. Once we swallow the food so many complex things occur there is absolutely no way to keep track of everything that happens during the digestive process.So let us put everything together. Remember the closed system versus the open system. In a closed system we know everything and I mean everything that is happening. In the open system we know very little as there are so many different variables. So my problem with the calorie is that it is only useful if you want to know how much heat will be generated from the food you ate. That is it.

Not to sound silly but when we eat food the food does not just go into the belly and get burned up and that's it. Humans do not burn food, we digest it. To say there is four hundred calories in a given food item disregards the fact and I mean fact, that the calorie only tells us how much heat will be given off when you burn the food in a closed, regulated environment.

I ask again, "What does the calorie have to do with human nutrition?' And my answer remains the same--Nothing. That is why when many of my patients increase their caloric intake, which we know now means nothing anyway, they lose weight. This is because they are eating foods which encourage the whole fat burning process. And when you put into motion the fat burning process not only are you not storing fat, but also you are not making cholesterol, your blood pressure lowers and your blood sugars normalize. But these are subjects for other chapters.

If, on the other hand, one eats carbs now you wll set into motion all the body needs to make all the bad stuff. It just so happens that one-gram of carbs and protein contain four calories, whereas one gram of fat contains nine calories. This is why we are told to avoid fat because it has more calories than carbs and protein per gram. The reasoning is that if we eat fat we ingest more calories to burn as opposed to the consumption of carbs and protein. And then, the argument continues, you will get fatter by eating the fat, again, because it contains more calories.

As a side note, notice that whenever we talk about calories we use the word 'burn'. Like, since you ate all that fat, now you have to 'burn' it off. Or, I ate so much when I was on vacation I have to 'burn' it all off now. Well, where do you think this term 'burn' is derived from? Exactly, from the same way we determined the calorie in the first place; remember we 'burned' the stuff in the container.

So when I am in the examining room with my patients and the term calorie comes up, I immediately tell them that the calorie is irrelevant. I tell them that a calorie measurement is only useful if you want to know how much heat is given off when you burn something. I also add that our bodies do not work that way, we do not burn, we digest. I explain about the calorimeter and tell them this container burns things, it does not digest like we do. And the final thing I say is that if "I were king for a day, I would eliminate the term calorie from all the side packaging information labels." What would I put there? How many carbs, protein, fat, cholesterol, vitamins, minerals, fiber, sugar alcohols (which we will talk about later), and to list the presence or absence of trans fats (which we will talk about later as well).

About Me

I am a Board Certified Family Physician and Nutritional Biochemist and have been in the practice of medicine for over 19 years.
I graduated from Centereach HS in 1983;
From Cornell University, with degrees in biochemistry and molecular cellular biology in 1988, in Ithaca, NY;
From the NY College of Osteopathic Medicine in 1993, in Old Westbury,NY.
Was the Chief Resident of my Family Medicine Residency from 1994-1996;
Received an MBA with Honors from Regis University in Denver,CO.
and also received a Juris Doctorate from Concord University School of Law, located in Los Angeles,CA.
I am the author of GENOCIDE: How Your Doctor's Dietary Ignorance Will Kill You.